Open surgical techniques in which incisions of at least several centimeters in length are made to access the surgical area have many limitations and often lead to post-operative complications. One common problem is permanent, cosmetically unappealing scars.
Minimally invasive surgical techniques, e.g., laparoscopic surgery, reduce the overall size of scars, but do not eliminate scarring of the skin. Furthermore, whenever the peritoneum, the lining of the abdominal cavity, is cut or punctured, transforming growth factors, such as TGF-.beta., are released as part of the healing process. Even the small punctures associated with laparoscopy initiate the release of these substances. The growth factors induce the healing process and cause the formation of band-like connective tissue bridges known as adhesions. Adhesions can cause bowel obstructions in which the intestines twist around the adhesions and become kinked. Frequently, surgery is needed to correct the bowel obstruction and remove the adhesions. Unfortunately, the corrective surgery itself results in the release of transforming growth factors and leads to the formation of new adhesions, which can cause new bowel obstructions.
One way to avoid external scarring and the formation of adhesions would be to eliminate the need to cut the peritoneum by accessing internal body parts through a natural body opening. An example of such a technique that has been known at least for several decades is culdoscopy. During a culdoscopic procedure, an endoscopic instrument is introduced through the posterior vaginal wall to view the rectovaginal pouch and pelvic viscera. U.S. Pat. No. 4,103,680 discloses a device and method for applying elastic rings, that inter alia, can ligate fallopian tubes in connection with culdoscopic procedures.
Another natural body opening that would allow access to many internal organs in the body is the rectum. For example, an appendectomy could be conducted by gaining access to the abdominal cavity by perforating the colon. U.S. Pat. Nos. 5,458,131 and 5,297,536 disclose a method for intra-abdominal surgery in which access to the abdominal cavity is through a natural body cavity, such as the colon.
However, the most serious limitation that renders the above approach impracticable as described in the above patents are issues related to sterility. An enormous body of medical literature teaches that inadvertent perforation of the bowel could lead to serious, potentially lethal infections. An inadvertent perforation of the bowel could result in the bowel contents seeping into the abdominal cavity. This could result in sepsis. The general attitude in the surgical community is to avoid perforating the bowel because of the inability to create and maintain a sterile atmosphere in the abdominal cavity when the bowel is perforated.
Despite the significant advantages of performing surgery on internal body parts through a natural body cavity such as the colon (no scarring, no adhesions and faster patient recovery post-surgery), this procedure is currently not practiced because of the lack of a method and devices that provide a sterile path from the natural body opening through the natural body cavity to the body parts. The existing procedures or publications, such as the above-identified patents, generally do not teach a method or describe a device for maintaining a sterile route through a natural body opening such that an internal body organ could be accessed through a body cavity.
Thus, there exists a need for a device and method that would provide a sterile path for accessing internal body parts and performing surgery on those internal body parts.